A. Alberti

Prevalence and Incidence of Cholecystolithiasis in Cirrhosis and Relation to the Etiology of Liver Disease

To assess prevalence and incidence of cholecystolithiasis in cirrhosis, 356 consecutive cirrhotics and 247 consecutive cases of chronic hepatitis without cirrhosis were studied by ultrasonography. Cholecystolithiasis was significantly more frequent in cirrhotics than in patients with chronic hepatitis (p < 0.001) after stratification for age and for alcohol abuse, and its prevalence in the former was affected by Childs class (p < 0.001) and duration (p < 0.001) of cirrhosis and was higher in HBsAg-negative as compared with HBsAg-positive cases (36.2 vs. 11.9%) and in patients with previous alcohol abuse (41.5 vs. 28.3%), while no difference was noted in relation to sex. By multivariate analysis, duration and Childs class of cirrhosis and HBsAg-negative status were statistically associated with cholecystolithiasis. One hundred and eighty-two of the 356 cirrhotic patients without gallstones at inclusion were followed prospectively, and 21 (11.5%) of them developed cholecystolithiasis, and duration of cirrhosis and past alcohol abuse were found to be independent risk factors for gallstone development by multivariate analysis. Cirrhosis is a significant risk factor for cholecystolithiasis, except for HBsAg-positive patients who have prevalence and incidence similar to noncirrhotics. Severity and duration of cirrhosis and previous alcohol abuse are associated with an increased risk of gallstone formation.

Chronic evolution of acute hepatitis type B: Prevalence and predictive markers

SummaryDuring a prospective study of acute symptomatic viral hepatitis, started in 1978, 664 consecutive adult patients, including 223 drug abusers, fulfilled the diagnostic criteria (anti-HBc IgM positivity) for acute type B hepatitis. In order to evaluate the outcome of the disease, 443 patients were followed for up to 12 months after the onset. 2.4% of the infections became chronic; the rate did not significantly differ between drug addicts and non-drug abusers, suggesting that chronic hepatitis is a rare complication of acute symptomatic hepatitis type B. Ongoing liver damage after clearance of HBsAg from serum was observed in drug abusers only (14% of the cases). Clinical, biochemical and virological features of the acute phase in patients with ongoing infection were compared with those of uncomplicated cases. Anicteric hepatitis and lower transaminase values were significantly (p<0.05) associated to a chronic evolution of the disease, as well as a higher prevalence of HBV-DNA, DNA polymerase and HBcAg positivity in serum. Testing HBV-DNA and DNA polymerase early in the course of the infection appeared to be of high predictive value for the subsequent outcome of the illness.ZusammenfassungIm Verlauf einer 1978 begonnenen, prospektiven Studie über die akute symptomatische B-Virus-Hepatitis wurde die Diagnose bei 664 Patienten gesichert (anti-HBc IgM-positiv); in dieser Gruppe waren 223 Drogensüchtige und 441 Nicht-Drogensüchtige. Verlaufsbeobachtungen erfolgten bei 443 der Patienten bis zu 12 Monate nach Ausbruch der Krankheit. 2,4% der Infektionen nahmen einen chronischen Verlauf, dabei bestanden zwischen den Drogensüchtigen und Nicht-Drogensüchtigen keine signifikanten Unterschiede. Dies deutet darauf hin, daß die akute symptomatische B-Virus-Hepatitis nur selten in die chronische Form übergeht. Ein Fortschreiten der Leberschädigung nach dem Verschwinden von HBsAg aus dem Serum wurde nur bei Drogensüchtigen (14% der Fälle) beobachtet. Die klinischen, biochemischen und virologischen Parameter der akuten Krankheitsphase wurden bei Patienten mit persistierender HBV-Infektion und bei Patienten mit unkompliziertem Verlauf verglichen. Eine anikterische Hepatitis und niedrigere Transaminasenwerte sowie eine höhere Prävalenz der HBV-DNA, DNA-Polymerase und HBcAg-Positivität waren signifikant mit einem chronischen Verlauf assoziiert (p<0,05). Die Testung der HBV-DNA und DNA-Polymerase in der Frühphase der Infektion hat sich als sehr wertvoll für die Prognose des weiteren Krankheitsverlaufes erwiesen.

Antibody to the hepatitis B virus receptor for polymerized albumin in acute infection and in hepatitis B vaccine recipients

A receptor for polymerized human serum albumin is encoded by the pre-S region of the hepatitis B virus genome and may mediate attachment of the virion to hepatocytes. To investigate antibody response to the virus receptor we studied sera and their IgG fractions for inhibitory activity on hemagglutination of polyalbumin-coated red cells by virus particles containing the pre-S polypeptide. By this method antibody to the receptor was detected in serum in a goat immunized with pre-S containing particles, with no relation to levels of antibody to hepatitis B surface antigen, and in the sera of 33% and 83%, respectively, of acute hepatitis B patients studied during the early phase of illness and during convalescence. In contrast, antibody to the receptor was not detected in serum in any of the 47 subjects immunized with a commercial, plasma-derived, hepatitis B vaccine. These results demonstrate that natural acute infection with hepatitis B virus leads to production of antibody to the virus receptor for polyalbumin, while such antibody response is absent after immunization with currently licensed hepatitis B vaccines.

A randomized controlled trial of thymopentin therapy in patients with chronic hepatitis B

Strategies of treatment of chronic hepatitis type B are currently based on the use of either antiviral or immunomodulatory agents. A randomized, controlled trial was performed to assess the safety and efficacy of 6-month thymopentin therapy in 30 patients with chronic hepatitis B. Inclusion criteria were biopsy-proven chronic hepatitis, elevated alanine aminotransferase and serum HBsAg and HBV-DNA positivity for at least 12 months. At the conclusion of the study (1 year), HBV-DNA was negative and alanine aminotransferase had normalized in 13% and 20% of treated cases and in 20% and 27% of controls. None of the ten treated and one of the nine control patients who were initially HBeAg positive subsequently cleared HBeAg. None became HBsAg negative. A histologic improvement was noted in 27% of the treated patients compared with 18% of controls. These results indicate that this regimen of thymopentin therapy is not effective in treating chronic hepatitis B.

Virological Changes in Chronic Hepatitis Type B Treated with Levamisole

8 children, known to have been hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) positive for more than 6 months and with chronic active hepatitis on biopsy, received 2.5 mg levamisole/kg/day, 2 days a week for 6-18 months. In 6 of the 8 children transaminases normalized within 4-18 months of therapy, with seroconversion to antibody to HBeAg (anti-HBe) and disappearance of HBV-DNA polymerase from serum and of hepatitis B core antigen (HBcAg) from liver. In these cases liver biopsies taken after treatment showed histological regression to chronic persistent hepatitis. Two distinct patterns of response to levamisole were noted: patients having higher pretreatment transaminase levels and lower expression of HBcAg in the liver showed an early transaminase normalization and anti-HBe seroconversion with therapy, while in patients with less active disease and more diffuse HBcAg positivity in pretreatment liver biopsies, longer treatment periods were necessary to achieve these effects. Our results suggest that long-term levamisole therapy may be beneficial in HBeAg-positive chronic hepatitis type B.

Retreatment of chronic hepatitis C (CHC) with sequential interferon-ribavirin combination (IFN-RIBA) therapy

Most patients with CHC have transient response (Relapsers-R) or no response (NR) when treated with IFN. To assess efficacy of IFN-RIBA in these patients, 50 R and 50 NR after IFN therapy were randomized to be retreated with IFN alone or with IFN-RIBA. IFN was given to all cases at 6MU tiw and at 2 mo patients were randomized to continue with IFN alone or to add RIBA 1800-1200 mglday) for 6 mo. ALT and HCV-RNA (PCR) End Theraov Resoonse and Sustained (12 mo) Resoonse are shown in the table. Previous NR (ALT) ETR(RNA) (ALT) SR (RNA) IFN monotherapy (24) 5(21 %I 3(12%) 0 0 IFN-RIBA (241 12(50%) 4(16%) 1(4%1 0 Previnus R IFN monotherapy (26) 1 16(61X) 10(38%) 1 6(23%) 4(15%) IFN.RIBA (28) 1 22(85%1 18(69%) 1 14(54%) 12(46%) IFN-RIBA significantly improved rate of SR in R (P=O.O3) but not in NR, in which only ALT ETR was improved. IFN-RIBA vs IFN improved SR by 27% with HCV-1 and by 4% with HCV-213. SR rates were 27% and 40% respectively with IFN alone and IFN.RIBA in R after 3MU x 6 mo IFN while the corresponding figures for R after higher/longer IFN therapy were 7% and 57%. Addition of RIBA to IFN improved SR only in patients with normal ALT at randomization. In conclusion, IFN-RIBA combination therapy was superior to IFN monotherapy in retreating previous IFN relapsers, particularly those with HCV-1 and those who had already being treated with high dose IFN during the I” cycle. Our schedule of IFN.RIBA was not effective in previous IFN non responders. A NOVEL HEPATITIS E (HEY) ISOLATED FROM A PATIENT WITH ACUTE nA-C HEPATITIS IN ITALY L. Roman& E. Tanzi. A. Zanetti. G. Sl *Viral Discovery Group, Abbott Laboratories, USA Objective: To assess the aetiological role of HEV in acute nA-C hepatitis and to characterize a viral isolate from a patient with no history of travel to areas where HEV is endemic. P&t&s and methods: We studied 216 patients with nA-C hepatitis (negativity for IgM anti-HAV, HBsAg, IgM anti-HBc, anti-HCV, HCV-RNA and exclusion of autoimmunity, alcohol or hepatotoxic drugs). All sera were tested by EIA for both IgG (Abbott Labs) and IgM (in house assay) anti-HEV. Sera and stools (when available) collected during the acute phase were examined by nested RT-PCR using primers derived from the ORFl region. Oligonucleotide primers based on the 5’-end of the ORFl of HEV-US1 were used to identified an isolate from a patient with no known risk factors. Results: 22/216 (10.2%) patients were found HEV-RNA and IgM positive during acute phase (ALT mean peak 2768 IUil, range 396-12290). The acute disease had a benign course with ALT normalization in 3-5 weeks in 20 (91%) patients. One patient with a history of chronic hepatitis C died from fulminant hepatitis and 1 patient (co-infected with HAV) had a clinically severe course (ALT 12290 IU/l, AST 17870 IUil) with ALT normalization within 8 weeks. 17 (77.3%) acute hepatitis E infections occurred in patients who travelled in endemic areas and 5 (22.7%) in patients with no history of travel. Pairwaise alignments of the nucleotide sequence from a HEV F’CR positive patient with no history of travel indicate that the isolate is significantly divergent from the two original isolates of HEV Burma and Mexico (79.9 and 80.7% respectively) and also significantly divergent from the new US isolates (85.8-88.6%). Phylogenetic analysis indicates that the Italian isolate represents a fourth branch distinct from those represented by the Burmese, Mexican and US isolates. Conclusions: HEV is responsible of about 10% of acute nA-C hepatitis in Italy. The identification of a new HEV variant may be important in understanding the epidemiology of HEV infection in our country.

647 INSULIN DIRECTLY INHIBITS IFN-α SIGNALING IN HEPATIC CELLS THROUGH A SOCS3 INDEPENDENT PATHWAY

When HCVpp lacking the HVR were used (or when SRB1 was inhibited by BLT-4) serum enhancement was lost, particularly in HIV coinfected patients. In HIV patients, neutralization was positively and independently related to CD4 count (p < 0.01) and to antiretroviral therapy (p < 0.001). Selective pressure on HVR was higher in immunocompetent subjects and was related to the neutralization observed with serum immunoglobulin fraction. Conclusion: The sera of patients coinfected by HIV or liver transplanted are poorly neutralizing and facilitate the entry of HCVpp mainly through HVR and SRB1. Our findings are the first to show that low neutralization/high facilitation is related to the immune status and could be involved in the severity of HCV in immunocompromized subjects.